Three Ways to Handle Combative Patients

Have you ever encountered a combative patient? Handing combative patients can be tricky, whether they are verbally or physically abusive. Unfortunately, violent encounters are common when you work in the healthcare field, and code greys are called much more frequently than they should. We’ve compiled three ways to handle combative patients. 

When a patient is combative, it’s essential to understand the common causes of combativeness in patients. Most causes are metabolic or chemical in nature. 

The main metabolic causes can be remembered with the acronym AEIOU TIPS:

  • Acidosis or alcohol
  • Epilepsy
  • Infection
  • Overdose
  • Uremia
  • Trauma or tumor
  • Insulin
  • Psychosis
  • Stroke
  • Dementia

The leading chemical causes are: 

  • Cocaine 
  • PCP
  • MDMA (ecstasy) 
  • or mushrooms

Additional causes of a patient being combative are anxiety or Post Traumatic Stress Disorder. When dealing with a combative patient, you have to remember that they are not in their right minds, and internal factors should be considered. Try to remember what it feels like not to feel well or like yourself, and something upsets you. As care professionals, it’s important always to put yourself in their shoes first. 

How to Respond 

Don’t be the person who says, “calm down.” There are a few reasons for this, the first being that it doesn’t help the patient. Regardless of your intentions, telling someone to calm down when they feel a certain way just dismisses their feelings. This also doesn’t help you. Usually, when someone tells a combative patient to calms down, it only leads to more rage. Additionally, it doesn’t help the team. One provider telling a patient how to feel or what to do tends to wind everyone up. The next person who speaks is likely to get ignored and get backlash. The entire team needs to have unity and the same tone to be effective. 

Instead, let the calmest provider speak to the patient. This is generally a social worker at the hospital. Always speak softer than you think is necessary. We understand that it is human nature to want to yell when you want to be heard, or when someone is yelling, it’s easy to talk at their pitch, but this does no one any good. Speak softly, and the volume of all communication on scene will follow suit. 

1. Use the patient’s name. 

If you know the patient’s name, use it. Always explain what you are doing before you do it. Bill, we need to lay still, we here to help you. Help us take care of you, Bill. The more personal you can make it, the better. Using the patient’s name sends an unspoken message to the patient that their identity is important. Using the patient name also reminds everyone involved that there is a real human being on the opposite end of all of this conflict.

2. Use the jury test. 

If you watch Court TV shows or movies, you know it’s all about the evidence. When there’s a video, someone is almost always caught red-handed. Let’s say you were called into questions, and the jury was to decide if your care was appropriate. Imagine the volume was turned off, and you had to explain what you were doing and what was going on. Always think of this scenario. Make sure that your soft-spoken voice, hand gestures, and body language are appropriate for the situation. Under no circumstances should you also be aggressive with the patient either in your body language or as a response to the patient’s harsh words or combative actions. 

3.Code gray

In some hospitals, code gray is a call for security personnel when a patient is overly combative, and there’s nothing more the team can do. Security personnel can assist other hospital staff in resolving the situation or removing the person from the premises if necessary. Often, this is the last step when handling a combative patient. 

Dealing with a combative patient is never fun, and it’s not something most of us are taught in school, or receive proper self-defense training on. However, if you use the steps above, you should be able to calm the patient down and make them feel like they are in a safe place. 

Have you dealt with a combative patient? What were some tactics that you used that worked for you? Let us know in the comments below. 

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About the author

Ashley Carty

Ashley Carty is a seasoned medical professional with over 8 years of experience working at the top hospitals in Southern California, including Hoag, Saddleback Memorial, and UCSD.

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